Chiou J F, Liu M T, Lai Y L, Chang K H
Department of Radiation Oncology, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C.
J Formos Med Assoc. 1993 Feb;92(2):165-73.
High-dose-rate (HDR) afterloading brachytherapy has been used at Mackay Memorial Hospital since 1984 for the treatment of gynecological malignancies. From October 1984 to October 1990, a total of 321 previously untreated patients with biopsy proven uterine cervical cancer were treated with radiation therapy with curative intent. According to FIGO staging, the patients were grouped into stage I (19 patients), stage IIA (13 patients), stage IIB (96 patients), stage III (158 patients) and stage IVA (35 patients). All patients received a combination of external beam irradiation plus intracavitary brachytherapy using the Buchler Remote Afterloading (RAL) system. For most cases, external beam irradiation using a Co-60 or Clinac 1800 photon beam (6 MV or 15 MV) of 3,060 cGy to 3,960 cGy was given to the whole pelvis (180 cGy/day, five days/week), followed by a midline shield after RAL. The total dose to the pelvic sidewall was 5,040 cGy to 5,400 cGy. The overall actuarial five-year survival rate was 55%. The total complication rate in a follow-up of two to eight years was 1% to 4%, and a good correlation existed between rectal complications and the calculated rectal dose. We conclude that fractionated HDR intracavitary therapy concurrent with teletherapy can achieve a high regional control rate with few complications, and can reduce the cost of hospitalization and the risk of anesthesia.
自1984年起，麦凯纪念医院便开始采用高剂量率（HDR）后装近距离放射疗法治疗妇科恶性肿瘤。1984年10月至1990年10月期间，共有321例经活检证实为子宫颈癌且未经治疗的患者接受了旨在治愈的放射治疗。根据国际妇产科联盟（FIGO）分期，患者被分为I期（19例）、IIA期（13例）、IIB期（96例）、III期（158例）和IVA期（35例）。所有患者均接受了外照射与腔内近距离放射疗法相结合的治疗，腔内近距离放射疗法使用的是布赫勒遥控后装（RAL）系统。在大多数情况下，采用钴-60或Clinac 1800光子束（6兆伏或15兆伏）对全盆腔给予3060厘戈瑞至3960厘戈瑞的外照射（180厘戈瑞/天，每周5天），随后在RAL后进行中线屏蔽。盆腔侧壁的总剂量为5040厘戈瑞至5400厘戈瑞。总体精算五年生存率为55%。在2至8年的随访中，总并发症发生率为1%至4%，直肠并发症与计算得出的直肠剂量之间存在良好的相关性。我们得出结论，分次HDR腔内治疗与远距离治疗同时进行可实现较高的区域控制率，并发症较少，并可降低住院费用和麻醉风险。
